Gastroenterology

Gastroenterology

Volume 128, Issue 4, April 2005, Pages 849-855
Gastroenterology

Clinical-alimentary tract
Fertility and pregnancy-related events in women with celiac disease: A population-based cohort study

https://doi.org/10.1053/j.gastro.2005.02.017Get rights and content

Background & Aims: Previous studies have raised concern about reduced fertility and increased adverse pregnancy-related events in women with celiac disease, but none has estimated overall fertility compared with the general female population. Methods: We compared computerized primary care data for 1521 women with celiac disease with data for 7732 age- and practice-matched women without celiac disease. We estimated population-based rates of fertility and adverse pregnancy outcomes. Results: Crude fertility rates were 48.2 and 47.7 live births per 1000 person-years for women with and without celiac disease, respectively (rate ratio, 1.01; 95% confidence interval, 0.90–1.14). Age-specific fertility rates showed that women with celiac disease had lower fertility when younger but higher fertility when older compared with women without celiac disease. This increase in relative fertility with increasing age held whether women had treated or untreated celiac disease. Risks of cesarean section (odds ratio, 1.33; 95% confidence interval, 1.03–1.70) and miscarriage (rate ratio, 1.31; 95% confidence interval, 1.06–1.61) were moderately higher in women with celiac disease, but risks of assisted birth, breech birth, preeclampsia, postpartum hemorrhage, ectopic pregnancy, stillbirth, and termination were similar. Conclusions: Overall, women with celiac disease have fertility similar to that of the general female population, but they have their babies at an older age. Although our findings may reflect a disease effect, the age shift in fertility rates and the increase in cesarean section risk is consistent with socioeconomic or educational advantages of women with celiac disease.

Section snippets

Materials and methods

We obtained data from the General Practice Research Database (GPRD), a source of longitudinal records of routine primary care visits for more than 8 million people registered at general practices across the United Kingdom.21, 22 Participating practices must record all major diagnoses, medical events, and prescriptions, and audits are performed regularly to ensure that practice data are kept up to standard by including at least 95% of this information. Aggregated data are anonymized for research

Study population

From our initial cohort of 4732 people with celiac disease and 23,620 comparison subjects,28 we identified 1521 and 7732 potentially fertile women, respectively, who were included in our study. There were no differences in the age at first birth (χ2 test for trend; P = .76) or in the total number of births between the 2 cohorts (χ2 test for trend; P = .87) (Table 1). Women with celiac disease were more likely to have never smoked (χ2; P < .01) and to have a lower body mass index (χ2 test for

Discussion

In this large general population–based cohort study, we found that overall fertility rates are the same in women with diagnosed celiac disease compared with women in the general population. However, women with celiac disease tend to have their babies at an older age. The pattern of relative fertility increasing with age was similar in women with prevalent or incident celiac disease in our study. Within the incident group, we were additionally able to investigate whether their fertility changed

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    Supported by The Wellcome Trust (grant 063800).

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